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Clinical Advances in Extracorporeal Membrane Oxygenation (ECMO)
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Clinical Advances in Extracorporeal Membrane Oxygenation (ECMO)

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Intensive Care".

Deadline for manuscript submissions: closed (9 February 2025) | Viewed by 8837

Special Issue Editors

Dr. Sung-Min Cho

E-Mail Website
Guest Editor
Division of Neurosciences Critical Care, Department of Neurology, Surgery, Anaesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21218, USA
Interests: extracorporeal membrane oxygenation; stroke; cardiopulmonary resuscitation; brain injury; intracranial hemorrhage
Special Issues, Collections and Topics in MDPI journals
Dr. Akram Zaaqoq

E-Mail Website
Guest Editor
Department of Anesthesiology, Division of Critical Care, University of Virginia, Charlottesville, VA 22903, USA
Interests: critical care medicine; intensive care medicine; sepsis; resuscitation; cardiopulmonary resuscitation
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The use of extracorporeal membrane oxygenation (ECMO) has dramatically increased in the last decade. Veno-Arterial (V-A) ECMO is the most common strategy for the rescue of refractory cardiac failure, and Veno-Venous (VV) ECMO is employed for refractory respiratory failure. Innovative and new therapies, monitoring strategies, and clinical evidence/research are being continually developed in the field of ECMO. As advances in therapeutics, technology, and management strategy have improved outcomes in the field of ECMO, improving adverse events such as on-ECMO complications and organ dysfunction is of the utmost importance in patients with ECMO support. Therefore, it is critical that ECMO providers are up to date on these new developments and how they are related to outcomes to provide appropriate critical care for our patients. In this Special Issue, we welcome authors to submit papers on the recent advances in translational and clinical research in V-A and V-V ECMO.

Dr. Sung-Min Cho
Dr. Akram Zaaqoq
Guest Editors

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Keywords

  • extracorporeal membrane oxygenation
  • ECMO
  • multi-organ failure
  • outcomes
  • V-A ECMO
  • ECPR
  • V-V ECMO
  • translational research
  • clinical research

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Published Papers (5 papers)

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Research

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9 pages, 201 KiB  
Article
Application Results of an Extracorporeal Therapy Protocol in Cardiorespiratory Arrest: A Historical Cohort Study
by Jordi Castillo-Garcia, Albert Ariza-Solé, Eric Moral-González, Fabrizio Sbraga, Albert Gil-Dorado and Jose-Carlos Sánchez-Salado
J. Clin. Med. 2025, 14(6), 1842; https://doi.org/10.3390/jcm14061842 - 9 Mar 2025
Viewed by 487
Abstract
Background/Objectives: This study sought to evaluate the clinical profile, in-hospital management, prognosis, and survival of patients treated for cardiac arrest using extracorporeal therapy in a third-level Spanish hospital before and after the therapy was protocolised. Methods: This study is a historical [...] Read more.
Background/Objectives: This study sought to evaluate the clinical profile, in-hospital management, prognosis, and survival of patients treated for cardiac arrest using extracorporeal therapy in a third-level Spanish hospital before and after the therapy was protocolised. Methods: This study is a historical single-centre cohort study that was conducted from January 2009 to February 2024. In 2019, an in-hospital extracorporeal reanimation therapy protocol was established in the centre’s Coronary Intensive Care Unit. As a result, the cohort was split into two groups: the Pre-Protocol group (between 2009 and December 2018) and the Post-Protocol group (between 2019 and February 2024). Results: A total of 26 patients were recruited, i.e., 10 in the first cohort and 16 in the second, with acute myocardial infarction being the most prevalent cause in both cohorts. A 30% (3) to 43.65% (7) increase in survival was observed between the two cohorts (p = 0.48), with CPC 1–2 neurological functionality exceeding 85% of cases in both cohorts (p = 0.7). The mean time from cardiac arrest to the application of extracorporeal therapy decreased from 104.1 min to 41.87 min (p = 0.09). The longer duration of ECMO (p = 0.03) and the longer hospital stay (p = 0.002) are due to a higher survival. Conclusions: The results show a trend in improvement outcomes. The small cohort size makes it difficult to draw robust conclusions, but we want to highlight the importance of applying a specific protocol based on standardised patient selection criteria and the establishment of extracorporeal reanimation therapy. Full article
(This article belongs to the Special Issue Clinical Advances in Extracorporeal Membrane Oxygenation (ECMO))
11 pages, 963 KiB  
Article
Comparative Efficacy of Extracorporeal Versus Conventional Cardiopulmonary Resuscitation in Adult Refractory Out-of-Hospital Cardiac Arrest: A Retrospective Study at a Single Center
by Juncheol Lee, Yong Ho Jeong, Yun Jin Kim, Yongil Cho, Jaehoon Oh, Hyo Jun Jang, Yonghoon Shin, Ji Eon Kim, Hee Jung Kim, Yang Hyun Cho, Jae Seung Jung and Jun Ho Lee
J. Clin. Med. 2025, 14(2), 513; https://doi.org/10.3390/jcm14020513 - 15 Jan 2025
Viewed by 948
Abstract
Background: Extracorporeal cardiopulmonary resuscitation (ECPR) has the potential to improve neurological outcomes in patients with refractory out-of-hospital cardiac arrest (OHCA), offering an alternative to conventional cardiopulmonary resuscitation (CCPR). However, its effectiveness in OHCA remains controversial despite advancements in resuscitation techniques. Methods: This retrospective [...] Read more.
Background: Extracorporeal cardiopulmonary resuscitation (ECPR) has the potential to improve neurological outcomes in patients with refractory out-of-hospital cardiac arrest (OHCA), offering an alternative to conventional cardiopulmonary resuscitation (CCPR). However, its effectiveness in OHCA remains controversial despite advancements in resuscitation techniques. Methods: This retrospective single-center study compared neurological outcomes and 30-day survival between ECPR and CCPR patients from January 2014 to January 2022. Patients aged 18–75 with witnessed OHCA, minimal no flow and low flow times, and cardiac arrests occurring at home or in public places were included. All patients were transported directly to our institution, a tertiary medical center serving the southeastern region of Seoul, where extracorporeal membrane oxygenation implantation was consistently performed in the emergency department. Neurological outcomes were assessed using Cerebral Performance Category scores, with good outcomes defined as scores of 1–2. Statistical analyses included logistic regression models and Kaplan–Meier survival curves, adjusted for confounders using inverse probability of treatment weighting. Results: ECPR was associated with significantly better neurological outcomes than CCPR (p < 0.001). Factors predicting poor outcomes included older age and longer low flow times, while male sex and shockable rhythms were protective. No significant difference was found in 30-day survival between the ECPR and CCPR groups, although a trend toward better survival was noted with ECPR. Conclusions: ECPR may improve neurological outcomes in patients with refractory OHCA compared to CCPR, although it does not significantly affect 30-day survival. Further studies are necessary to validate these findings and explore the long-term impacts of ECPR. Full article
(This article belongs to the Special Issue Clinical Advances in Extracorporeal Membrane Oxygenation (ECMO))
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15 pages, 1287 KiB  
Article
Neuron-Specific Enolase as a Predictor of Neurologic Outcomes in Extracorporeal Cardiopulmonary Resuscitation Patients
by Yong Ho Jeong, Suk Kyung Lim, Yongil Cho, Yun Jin Kim, Hyo Jun Jang, Yang Hyun Cho, Yonghoon Shin, Jae Seung Jung, Jin Kook Kang, Sung-Min Cho and Jun Ho Lee
J. Clin. Med. 2024, 13(14), 4135; https://doi.org/10.3390/jcm13144135 - 15 Jul 2024
Cited by 1 | Viewed by 1472
Abstract
Background: Neuron-specific enolase (NSE) has traditionally been used as a biomarker to predict neurologic outcomes after cardiac arrest. This study aimed to evaluate the utility of NSE in predicting neurologic outcomes in patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR). Methods: This observational cohort study [...] Read more.
Background: Neuron-specific enolase (NSE) has traditionally been used as a biomarker to predict neurologic outcomes after cardiac arrest. This study aimed to evaluate the utility of NSE in predicting neurologic outcomes in patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR). Methods: This observational cohort study included 47 consecutive adult ECPR patients (median age, 59.0 years; 74.5% males) treated between January 2018 and December 2021 at a tertiary extracorporeal life support center. The primary outcome was a poor neurologic outcome, defined as a Cerebral Performance Category score of 3–5 at hospital discharge. Results: Twelve (25.5%) patients had abnormal findings on computed tomography of the brain. A poor neurologic outcome was demonstrated in 22 (46.8%) patients. The NSE level at 72 h after ECPR showed the best prediction power for a poor neurologic outcome compared with NSE at 24 and 48 h. A cutoff value exceeding 61.9 μg/L for NSE at 72 h yielded an area under the curve (AUC) of 0.791 for predicting poor neurologic outcomes and exceeding 62.1 μg/L with an AUC of 0.838 for 30-day mortality. Conclusions: NSE levels at 72 h after ECPR appear to be a reliable biomarker for predicting poor neurologic outcomes and 30-day mortality in ECPR patients. Full article
(This article belongs to the Special Issue Clinical Advances in Extracorporeal Membrane Oxygenation (ECMO))
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Review

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26 pages, 5846 KiB  
Review
Managing Refractory Hypoxemia in Acute Respiratory Distress Syndrome Obese Patients with Veno-Venous Extra-Corporeal Membrane Oxygenation: A Narrative Review
by Arnaud Robert, Patrick M. Honoré, Pierre Bulpa and Isabelle Michaux
J. Clin. Med. 2025, 14(5), 1653; https://doi.org/10.3390/jcm14051653 - 28 Feb 2025
Viewed by 1624
Abstract
Veno-venous extracorporeal membrane oxygenation (vvECMO) is a life-saving intervention for severe respiratory failure unresponsive to conventional therapies. However, managing refractory hypoxemia in morbidly obese patients poses significant challenges due to the unique physiological characteristics of this population, including hyperdynamic circulation, elevated cardiac output, [...] Read more.
Veno-venous extracorporeal membrane oxygenation (vvECMO) is a life-saving intervention for severe respiratory failure unresponsive to conventional therapies. However, managing refractory hypoxemia in morbidly obese patients poses significant challenges due to the unique physiological characteristics of this population, including hyperdynamic circulation, elevated cardiac output, and increased oxygen consumption. These factors can limit the effectiveness of vvECMO by diluting arterial oxygen content and complicating oxygen delivery. Refractory hypoxemia in obese patients supported by vvECMO often stems from an imbalance between ECMO blood flow and cardiac output. Hyperdynamic circulation exacerbates the recirculation of oxygenated blood and impairs the efficiency of oxygen transfer. To address these challenges, a stepwise, individualized approach is essential. Strategies to reduce oxygen consumption include deep sedation, neuromuscular blockade, and temperature control. Cardiac output modulation can be achieved through beta-blockers and cautious therapeutic hypothermia. Optimizing oxygen delivery involves improving residual lung function; high positive end-expiratory pressure ventilation guided by esophageal pressure monitoring; prone positioning; and adjustments to the ECMO circuit, such as using dual oxygenators, larger membranes, or additional drainage cannulas. This review highlights the interplay of physiological adaptations and technical innovations required to overcome the challenges of managing refractory hypoxemia in obese patients during vvECMO. By addressing the complexities of high cardiac output and obesity, clinicians can enhance the effectiveness of vvECMO and improve outcomes for this high-risk population. Full article
(This article belongs to the Special Issue Clinical Advances in Extracorporeal Membrane Oxygenation (ECMO))
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15 pages, 2787 KiB  
Review
Echocardiographic and Point-of-Care Ultrasonography (POCUS) Guidance in the Management of the ECMO Patient
by Stephanie Cha and Megan P. Kostibas
J. Clin. Med. 2024, 13(9), 2630; https://doi.org/10.3390/jcm13092630 - 30 Apr 2024
Cited by 3 | Viewed by 3109
Abstract
Veno-arterial (V-A) and Veno-venous (V-V) extracorporeal membrane oxygenation (ECMO) support is increasingly utilized for acute cardiogenic shock and/or respiratory failure. Echocardiography and point-of-care ultrasonography (POCUS) play a critical role in the selection and management of these critically ill patients, however, there are limited [...] Read more.
Veno-arterial (V-A) and Veno-venous (V-V) extracorporeal membrane oxygenation (ECMO) support is increasingly utilized for acute cardiogenic shock and/or respiratory failure. Echocardiography and point-of-care ultrasonography (POCUS) play a critical role in the selection and management of these critically ill patients, however, there are limited guidelines regarding their application. This comprehensive review describes current and potential application of echocardiography and POCUS for pre-ECMO assessment and patient selection, cannulation guidance with emphasis on dual-lumen configurations, diagnosis of ECMO complications and trouble-shooting of cannula malposition, diagnosis of common cardiac or pulmonary pathologies, and assessment of ECMO weaning appropriateness including identification of the aortic mixing point in V-A ECMO. Full article
(This article belongs to the Special Issue Clinical Advances in Extracorporeal Membrane Oxygenation (ECMO))
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